This study proposes a practical classification system with preliminary feasibility in surgical approach selection for cage retropulsion. For symptomatic cases, early revision may yield better outcomes. Anterior surgery is recommended for L5-above segments with mild retropulsion, and posterior surgery is suggested for L5/S1 with severe retropulsion. In addition, anterior lumbar interbody fusion (ALIF) is a good option for L5/S1 with low-grade retropulsion when performed by experienced surgeon. Surgical success depends on tailored strategies considering revision timing, segments, and migration grade. But additional data are needed to confirm long-term safety and inform optimal management.
Zhao et al. (Mon,) studied this question.